Fascist violence reaped domestic tragedy in The Medium

But little discussion around The Medium had to do with its camera. Instead, the game’s narrative took flak for its handling of sensitive subject matter like childhood sexual abuse and depression.

The game’s primary monster, The Maw, is the product of a young girl’s sexual trauma. Richard, a former professor, was brought to the Niwa Resort by architect and former pupil Thomas to teach children art. He harbors a dark secret: as a child, he was savagely beaten by his step-father after his biological dad died in WWII. His only respite was Rose, a young Jewish girl whom he smuggled food to in clandestine garden meetings. Richard’s mother, also brutalized by her new husband, was pushed to a breaking point and reported him to the Nazi authorities for smuggling Jews. In the process, however, Rose was discovered on the family’s property and executed; when Richard finds her body, it sets in motion a lifelong fixation on young girls akin to Humbert’s obsession in Lolita. When Richard is brought to Niwa, he gives in to his perverse impulses and molests Lilianne—Thomas’ daughter and Marianne’s sister. The young girl, confined to a bunker as her father studies her preternatural abilities, retaliates in an emotional explosion that creates The Maw and subsequently destroys the Niwa Resort.

While this is a socially inconvenient depiction of child molestation, it is a true-to-life one. More often than not, severe childhood trauma can capture someone in arrested development and stunt their sexuality. Broadly, 33% to 75% of pedophiles were abused during childhood; their attraction is often a result of either parental harm or being molested themselves. To rationalize and explain an action is not to justify it, though, and The Medium is careful to not excuse Richard from the weight of his sins. Rather, it uses his sexual dysfunction as an overt critique of fascist ideology. On a subtextual level, the writers argue Nazism cuts psychological, emotional wounds into the psyche of anyone touched by its evil. This litigates fascism as a stunted ideology—gazing to the past at the expense of harm done to the present and doom sowed for the future.

The consequences of this plot beat come to a head at the game’s climax. Marianne and sister Lilianne are chased to a place they’ve both dreamed of since girlhood—at the end of a dock, facing down death. The Maw approaches both women, as Marianne brandishes a firearm in futility. She knows that The Maw exists because Richard hurt Lilianne, and that it is the out-sized product of her pain and grief. In this moment, Marianne understands that she has three choices: fire at The Maw, kill Lilianne, or shoot herself. Two are guaranteed to end the cycle for good; but only the most hopeless one leaves them alive, albeit for a few moments.

This is when the screen goes black. A single gunshot. Credits. That’s all, folks. This is not a “spoiler” or an “explanation” because—to this day—the fates of Marianne and Lilianne are a mystery. They’re a point of conjecture and debate, something to speculate on for years to come, unless Bloober intervenes with a follow-up. If they don’t, it stands as a haunting metaphor for the murky uncertainty of a future with depression and complex PTSD. On a metaphorical level, it’s the choice those who struggle with mental health issues must live with every day: end it all, hurt someone else, or go out fighting.

Contemporary claims that The Medium is somehow “irresponsible” in its portrayal of mental health are dubious, and in some respects willfully ignorant. Similar claims have not been levied en masse towards Silent Hill f, a game in which the protagonist must kill things while she avoids taking medication in order to not have a mental breakdown and murder her family—hardly “responsible” messaging itself. Which belies a deeper point: social responsibility is a slippery criteria by which to critique most art, and to do so is often to cushion oneself from works that handle difficult subject matter with no easy answers. This is especially true of horror, whose success hinges upon the exploitation of recurrent social anxieties difficult to discuss in mixed company. Indeed, this was an intended philosophy of The Medium—“the game’s statement is that there is no universal truth,” designer Wojciech Piejko told EuroGamer.

Further, while The Medium is led by a predominately male development staff, co-creator Marlena Babieno and narrative designer Barbara Kciuk put two more women on the core creative staff than have ever been on a Silent Hill title in that capacity. It’s telling of the games crit enterprise, then, that a game which litigates sexual trauma and its effects on cis women received more overt scrutiny for its messaging than Silent Hill f—a game with adjacent preoccupations written by men. It’s also disingenuous and simple-minded to assume all narratives house a moralistic “lesson” one must internalize; if anything is an actual harm to folks who struggle with mental health, it’s this standard. In 2016, Lights Out director David Sandberg had to publicly defend the downbeat ending of his paranormal parable for depression after audiences charged it with the same offense as The Medium: somehow “encouraging” suicide. Sandberg had to explain, publicly, that he lives with depression and the film is a metaphorical reflection of his own struggles. This is a mortifying position for any artist to be put in—and criticism akin to the moral alarmism of Siskel and Ebert.

Yet five years later, games discourse predictably circled its way back to the same hairy drain. The Medium was mostly buried under overlong video essays and objectively incorrect “explainers,” parroted by online commentators who used it as further flak against Bloober Team. The announcement of Silent Hill 2 was met with subsequent hostility by the Silent Hill fanbase and general horror gaming community, who charged the developer with permissive attitudes towards child abuse and encouragement of suicide for the Richard and Lilianne plot. But time moves on. Moralistic rage finds new targets. Silent Hill 2 was a rousing success, with director Jacek Zieba noting that “they proved people wrong” and that the team is “starting to stop feeling like the underdogs all the time.” The Medium seemed to hold water with Silent Hill 2 producer Motoi Okomoto, who also worked on Silent Hill f; the game’s influence is present throughout the 2025 title, most obviously in the scripted chase sequences. With Cronos in the rear view and Silent Hill ahead, the studio has weathered criticism to come out as one of gaming’s most durable, challenging developers with a lasting influence on a prolific horror property.

With that in mind, The Medium is long overdue wider reappraisal for both its impact and newfound relevance. Now available for PlayStation 5—as well as Switch and Mac—the game holds a startling urgency in a particularly cruel time for American geopolitics. As rich pedophiles contract violent thugs to terrorize migrants and birthright citizens alike, art that explores the close intersection of fascism, child abuse, and misogyny holds a specific prescience. Who is an acceptable loss—and how might that damn the generation that follows?